Healthwise: The Missing Link in HRT?

Local providers tout the benefits of testosterone for women in New Hampshire

Women experiencing perimenopause and menopause symptoms, like fatigue and hot flashes, often leave doctors’ offices with more questions than answers. Doctors may prescribe medications to treat low estrogen or progesterone, but these prescriptions may only partially address what women feel.     

In November 2025, the Food and Drug Administration removed the “black box” safety warnings from estrogen-based hormone therapy. Previously, the warning stated that estrogen therapies carried risks of breast cancer, cardiovascular disease and dementia. Later reviews found these risks were overstated, especially for women under 60. After the removal of the warning, interest in hormone replacement therapy skyrocketed, and some drug manufacturers struggle to meet the demand for estrogen products.

The FDA currently approves two types of hormone therapy for women approaching menopause, according to the American College of Obstetricians and Gynecologists. Women can take estrogen only, or a “combined hormone therapy” that includes estrogen and progesterone. 

However, no FDA-approved formulation of testosterone has been approved for women in the United States, prompting local health care providers to help fill that gap in treatment.

Salem Med Spa Offers Testosterone Treatment as part of HRT

“Women need testosterone,” says Jessica St. Jean, MSN, FNP-C, a board-certified family nurse practitioner and the founder of JSJ Aesthetics & Wellness. “We need it just as much as a man. We have three times more testosterone in our bodies than we have estrogen, and it’s a very important sex hormone for women.”

St. Jean established her aesthetics business in 2014, which also includes locations in Methuen and Medford, Mass., after a decade of caring for post-thoracic surgery patients at Brigham and Women’s Hospital. At JSJ Aesthetics, she offers a wide range of advanced cosmetic and wellness services, including Botox, microneedling and peptide therapy. She decided to include hormone replacement therapy services after learning more about its benefits in her health care training.

“Women walk in, and they say, ‘I have brain fog. I walk into the room, and I can’t remember what I’m there for. I’ve got joint pain. I’m a little more irritable. I have anxiety I didn’t notice before. I no longer have a libido like I used to. I’m gaining weight around my mid-section,’ ” St. Jean says. “Or they say, ‘My primary care provider says I’m depressed and want to give me a depression medication.’ Once I hear those signs and symptoms, I start diving into the consult.”

In your 30s, you’ll lose testosterone. In your 40s, progesterone. In your 50s, estrogen, St. Jean says. Even without lab work, she says women in their 50s could likely benefit from testosterone, progesterone and potentially estrogen, depending on where they are in their menopause journey.

Patients complete lab work before starting medication, but their symptoms matter just as much as their lab results. Because St. Jean does not accept medical insurance, she prescribes bioidentical hormones rather than the synthetic hormones that insurance typically covers.

There are many nontangible benefits of estrogen and progesterone, which patients may not feel as immediately as testosterone, St. Jean says. She offers patients options after carefully reviewing their blood work and calculating dosage based on their hormone levels. Patients with a history of clotting disorders or positive estrogen receptor cancer should not take estrogen, St. Jean says.

“But I can still give you testosterone, and I’m telling you, it makes you feel so much better,” she says.

Women who opt to try testosterone therapy get pellets inserted into their back fat every three to four months, and the drug is absorbed in their bodies over time. St. Jean measures their blood levels every five weeks. Often, bioidentical estrogen pellets can be inserted at the same time, although progesterone is given as an oral supplement taken
at nighttime, she says.

Testosterone therapy is not without risk. Common side effects include developing acne or facial hair. However, the 2025 study, “Testosterone: Strong Enough for a Man, but Made for a Woman,” published by the European Society of Medicine, dispels the myth that testosterone causes aggression or heart problems.

Many women report feeling better soon after receiving testosterone treatment, St. Jean says, which is why she’s passionate about including it as part of hormone replacement therapy treatment. She tells patients not to be surprised if their primary care provider or gynecologist isn’t on board with their treatment.

“It’s not their fault,” she says. “They don’t have the education and they’re still being told it’s not okay.”

Urogynecologist, Nurse Practitioner Open Practice to Address Midlife Health

Two traditional health care providers opened their own practice in April to better meet the needs of women suffering from perimenopause or menopause symptoms, and are quickly filling up their schedules. 

Dr. Veronica Triaca and Trisha Brooks, APRN, launched Restore Women’s Wellness in Concord to provide comprehensive, individualized care focused on midlife health, hormonal transitions and sexual health. 

Both women bring decades of experience in urogynecology and women’s health, and recognized a need for more patient education and treatment than traditional health care offers. They treat insomnia, hot flashes, and lack of libido, and support a wide range of hormone imbalances and sexual health disorders.

“Historically, there hasn’t been a lot of places for women to go get the treatment they need or feel heard,” Brooks says. “We wanted the autonomy to branch out and see patients in our own time.”

Like JSJ Aesthetics, Restore Women’s Wellness includes testosterone as part of its overall hormone replacement therapy approach. 

“If you were to ask for estrogen, most people won’t offer you testosterone,” Triaca says. “The reality is that there’s some synergy to that. We know that it does more than just address libido. It helps with muscle mass loss, which we drastically lose when we hit our perimenopausal and menopausal phase of life.”

A dip in women’s testosterone levels may also be attributed to the “brain fog” that women often describe, but Triaca says that the benefits of testosterone therapy for women are still not “100% written.”

“International guidelines from the International Menopause Society include testosterone,” she says. “From a global standpoint, it’s more accepted as part of the conversation. The biggest change is going to happen when it becomes a non-controlled substance, which can be a barrier to treatment.”

Before prescribing any medication, Triaca and Brooks spend up to an hour with women to carefully listen to patients, screen them and explain the benefits of HRT and the differences between a mist, a gel, a patch, or a pellet. They also answer questions and offer options in a supportive space.

“HRT, wellness, and feeling good are all fabulous goals, but when you look at the science, (what HRT provides) is longevity. And to me, for no other reason, that’s a reason to go on hormone replacement,” Triaca says. 

“You might feel better and have better sex, but you’re also going to live longer, and not break a hip. We’ve placed patients on statins because we know that’s a way to prevent bad cardiovascular outcomes. But we should be doing the same thing with HRT.”